Maggie McKay (Host): You probably know about arthritis, but have you ever heard of great toe arthritis? Today, Dr. Hayden Hoffler, a Board Qualified, Fellowship Trained Foot and Ankle Surgeon specializing in the treatment of foot and ankle disorders, will help us understand what it is and how to get relief. Welcome to A Bone to Fix from the Orthopedic Associates of Central Maryland Division.

Hello, I'm Maggie McKay, and I've got a bone to fix with you. Please tell us about arthritis in general, Dr. Hoffler.

Hayden L, Hoffler, DPM: Yes, arthritis in the foot and ankle is a very common condition. What it necessarily means is narrowing of the joint, which causes pain, sometimes inflammation, and then it's treated both non surgically or conservatively and surgically.

Host: And how does arthritis affect the toes?

Hayden L, Hoffler, DPM: So what can actually happen specifically in the big toe, is the joint can become narrow and the reason why; it's a huge pressure point. It takes on lot of body weight and is the last joint to leave during push off phase when walking. And so a lot of force is placed to the joint, which can therefore narrow it or cause cartilage breakdown, leading to the actual inflammation and narrowing of the joint and therefore pain.

Host: And what are the types and make of toe arthritis?

Hayden L, Hoffler, DPM: There's two different types in the great toe. The first one is Hallux Limitus, which is just general narrowing and a little bit of spurring. And what that means is essentially you're losing just a little bit of motion in the big toe joint which causes some pain and discomfort.

And then Hallux Rigidus is the more severe version. And what that means is limited to no motion in the big toe, meaning the big toe can barely go up and down, which causes severe pain and inflammation. And sometimes you're actually even able to feel the spurs because of the discomfort.

Host: And why does it happen and how?

Hayden L, Hoffler, DPM: So there's various causes. Number one is trauma, the least likely, but it can happen from an injury. Another option is overuse. People that are very active, young, people in the military, people that are still active, old can get it. There's also other factors, including age is most commonly in the fourth decade of life or later.

Women are a little more affected than men, athletes as well, and people who are constantly on their feet. And then the last reason is actually just other inflammatory arthropathies, such as rheumatoid arthritis, and even gout can lead to arthritis of the great toe joint.

Host: Oh my goodness. So if you already have arthritis somewhere else, you could get it in your big toe as well.

Hayden L, Hoffler, DPM: Correct.

Host: Oh, that does not seem fair. What does it feel like?

Hayden L, Hoffler, DPM: So, the biggest prognostic factor of diagnosing it is actually pain. There's limited motion in the big toe joint. It hurts when you walk is the most common complaint, that I see, or that you can actually feel the spur on top, which is, you know, discomfort not with walking, but with wearing shoe gear as well.

So it effects both weight bearing with shoe gear and actually walking barefoot.

Host: So you mentioned that it can be treated with surgery and without, can you walk us through both choices?

Hayden L, Hoffler, DPM: Absolutely. So whenever a patient comes in with me, I want to make sure they've exhausted all conservative options before even talking about surgery. And what some of those conservative options include; are footwear changes, you know, skipping a shoelace, padding the affected area. How do we limit your toe movement to decrease the pain you're having? Because when you move the toe, you're causing pain. So certain inserts can do that. Anti inflammatory medications, sometimes icing. And then the last non conservative actually is just a steroid injection into the joint to decrease some of that pain and inflammation they're having.

Host: And then what if they do need surgery?

Hayden L, Hoffler, DPM: So I always tell patients there's four different options for surgery of the great toe due to arthritis. Number one is just purely shaving off the bump that they feel either on top, on the side or a combination of both. The second is creating an osteotomy or a bone cut to allow the joint to actually decompress and therefore give some pain relief.

The third is arthroplasty or actually creating a joint with an implant where you're sawing off the bone spur and creating a joint, that way they can maintain some motion. And the last is arthrodesis or actually fusion and what that means is you're fusing the big toe to the bone behind it which is called your first metatarsal, therefore eliminating the joint. And therefore eliminating the pain as well.

Host: Oh my goodness. Well, you mentioned, you know, how it feels. How do you know if you might have these types of arthritis? What, what would the signs be?

Hayden L, Hoffler, DPM: So the biggest signs are losing motion in the big toe joint, pain, inflammation, and actually feeling a knot or a bump around your great toe joint.

Host: Dr. Hoffler, when is it time to get evaluated?

Hayden L, Hoffler, DPM: I always tell patients the biggest factor in getting evaluated is pain and affecting daily activities; affecting the way, taking out the trash, loading the dishwasher, walking up the stairs, causing pain and even limping or inflammation, that's the time to get checked out and start with some of these treatment options.

Host: Is there anything else you'd like to add that we didn't cover that people should know about great toe arthritis?

Hayden L, Hoffler, DPM: I always tell patients the one thing that they always tell me is they wish they would have come in sooner. And that's what I recommend patients is don't wait it out if you see a problem or if something doesn't feel right; get it checked out so that the appropriate treatment can be started as quickly and as efficiently and most, importantly, safely as possible.

Host: Great advice. Thank you so much for sharing your expertise. This information is so useful.

Hayden L, Hoffler, DPM: Absolutely. Thanks so much for having me.

Host: Again, that's Dr. Hayden Hoffler. To learn more about this condition and others that affect the foot or to schedule an appointment with one of our foot and ankle specialists, please visit us at MDBoneDocs.com. That's mdbonedocs.com. And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you.

Thanks for listening. This is A Bone to Fix from the Orthopedic Associates of Central Maryland Division. That's all for today. I'm Maggie McKay, and that was a bone that's fixed.